INTRODUCTION

The Anglo-Saxon term "plasma expander" indicates solutions of aqueous biologically inert substances and high molecular weight ( colloid ), used in transfusions after severe bleeding or as a blood substitute. In particular, since the artificial plasma , their function is to temporarily restore the volume of liquid to prevent circulatory collapse . It is a solution isooncotica, so unlike others, has a lasting effect (does not abandon the circulatory bed early). Among the plasma expanders may include: the dextran , jellies (Emagel), polyvinyl-pyrrolidone el ' hydroxyethyl starch . Plasma volume expanders are used for the treatment of circulatory shock. They restore vascular volume, stabilising circulatory haemodynamics and maintaining tissue perfusion. Two general categories of expander are used: crystalloids or colloids, or a mixture of both (Baskett, 1994; Astiz and Rackow, 1999). The crystalloids most commonly used are normal saline (0.9% NaCl) or lactated Ringer's solution. Colloids include Haemaccel, Gelofusin and the naturally occurring plasma substances (albumin, plasma protein fraction). Debate on the preferred type of volume expander is ongoing (Holt and Dolan, 2000). Albumin is normally present in the blood and constitutes 50-60% of the plasma proteins and 80-85% of the oncotic pressure. Plasma protein fraction consists of 88% albumin and 12% globulins. Plasma protein fraction is effective in maintaining blood volume but does not increase oncotic pressure.

3 linkages. urinary output. Dextran is used clinically in the prophylaxis of venous thrombosis and pulmonary embolism in patients undergoing surgery that carries a high risk of thromboembolic complications. and capillary perfusion. A single infusion of dextran circulating blood volume is increased maximally within a few minutes following infusion of dextran 40 and within 1 hour after dextran 70 or 75. in turn. Dextran 40. Dextran was first discovered by Louis Pasteur as a microbial product in wine. Dental plaque is rich in dextrans. also improves microcirculation independently of its volume-expanding effects. . decreases the attraction between erythrocytes and reduces erythrocyte rigidity which aids in passage through capillaries. Administration of volume expander products causes water to move from interstitial spaces into the intravascular space. This increased volume causes an increase in central venous pressure. unlike the higher MW dextran products. The exact mechanism of this activity is unknown. peripheral resistance. but it is believed to occur by minimizing erythrocyte aggregation and/or decreasing blood viscosity. cardiac output. Dextran is also formed by the lactic acid bacterium Lactobacillus brevis to create the crystals of tibicos. a water kefir fermented beverage which supposedly has some health benefits. branched glucan (polysaccharide made of many glucose molecules) composed of chains of varying lengths (from 3 to 2000 kilodaltons). and blood viscosity.) Dextran is synthesized from sucrose by certain lactic-acid bacteria. the best-known being Leuconostoc mesenteroides and Streptococcus mutans. Dextran 70 and dextran 75 all exert osmotic effects similar to those of albumin. The straight chain consists of α-1. stroke volume. which maintains erythrocyte electronegativity and. while branches begin from α-1. blood pressure. Dextran 40 is also believed to coat erythrocytes. It is used medicinally as an antithrombotic (antiplatelet). (For information on the numbering of carbon atoms in glucose. see the glucose article. to reduce blood viscosity. and a decrease in heart rate. thereby increasing the circulating blood volume. Chemical structure of dextran Mechanism of action Dextran produces volume expansion by increasing the oncotic pressure within the intravascular space. and as a volume expander in anemia. The duration of volume expansion usually lasts for approximately 24 hours for all of these products. albumin has little or clinical effect on circulating blood volume.6 glycosidic linkages between glucose molecules.DEXTRAN Dextran is a complex. In dehydrated patients.

Distribution 90% or more is protein bound. .8 g/dL. Metabolism Removed from plasma by the reticuloendothelial system.Pharmacokinetics  Absorption Majority of IM injections are absorbed within 72 h. at least 1 h should elapse before the remainder of the therapeutic dose is given. these values do not represent Cl of iron from the body. 15 kg (33 lb) or less is 12 g/dL. respectively. however.  Iron Deficiency Anemia Adults and Children older than 4 mo of age IM/IV For a table for determining requirement of Hgb restoration and iron stores replacement. refer to the product information. Elimination Half-life ranged from 5 to 20 h. Normal Hgb: more than 15 kg (33 lb) is 14. and most of the remaining iron is absorbed over 3 to 4 wk. give a 0. IV test doses should be administered at a gradual rate over at least 30 sec ( InFeD ) or over at least 5 min ( Dexferrum ). Iron is not easily eliminated from the body and the accumulation of iron can be toxic. Iron content of hemoglobin is 0.5 mL test dose by the same route. Weight. Mg blood iron/lb body weight = mL blood/lb body weight × g Hgb/mL blood × mg iron/g Hgb Factors contributing to the above formula are:      Blood volume is 65 mL/kg of body weight.     Dosage  Test dose IM/IV Prior to the first IV or IM iron dextran injection. Hgb deficit. The accompanying formula is applicable for dosage determination only in patients with iron deficiency anemia and it is not to be used for dosage determination in patients requiring iron replacement for blood loss.34%. however. Onset A few days. Anaphylactic reactions occurring following iron dextran injection are usually evident within a few min. which splits the drug into its components.

and to be available during the infusion of full dose. The "Hb" in the equation is the patient's current hemoglobin value. and run the test dose in over 10-15 minutes. 6. 2. NOTE: Potential for anaphylactic reaction requires the administration of test dose. 3. 14. With the M. to administer test dose.use single-dose ampoules. hang bag 500cc 0. present.D. .D. 4. hook the 50 ml bag with Fe dextran 25mg test dose into a side-port of the main IV tubing set. to stay in attendance. NOTE: M. 250 to 1000 ml of 0. Place IV access. Monitor patient for 15-20 minutes for signs of adverse reaction. Transfer 25 mg of dose into 1cc syringe and inject into the 50cc bag of 0.9 NS using an IMED cassette tubing and regulate IV to KVO.26 × LBW) Desired Hgb = the target Hgb in g/dL LBW = lean body weight in kg. Prepare full dose of Fe Dextran as ordered in 10cc syringe .8 .Hb)]/14.8 Note: in this calculation.8 is the desired final hemoglobin value.9 NS (or as ordered by M. carefully observing the patient's vital signs. Children weighing 5 to 15 kg (11 to 33 lb) Dose (mL) = 0. NOTE: Multi-dose vials of Fe dextran should not be used for IV administration due to their phenol content. 5.D.26 × W) Administration (procedure) 1.3 x wt (lbs) x 100 (14.The total amount of iron dextran in mL required to treat the anemia and replenish iron stores may also be approximated as follows: Adults and Children weighing more than 15 kg (33 lb) Dose (mL) = 0.9 NS diluent is recommended for the full dose of iron dextran. Obtain MD orders and ensure her/his ability to be in attendance. Dose calculation: Mg iron = [0.0442 (desired Hgb − observed Hgb) × LBW + (0.0442 (desired Hgb − observed Hgb) × W + (0.) NOTE: The use of 5% dextrose as diluent is associated with increased incidence of local pain and phlebitis.

In types of sport where weight is relevant. average power during the exertion increased by roughly 10 per cent when blood volume was elevated.9 NS 50cc bag. A masking agent may be used to cover up the use of another substance so that an athlete doesn’t test positive. would benefit from iron supplementation. There is debate about whether athletes are at an increased risk for iron deficiencies. While Dextran can be a pragmatic treatment for athletes that are anemic. D/C IV per institutional procedure. have been observed to receive an inadequate supply of iron Dextran. diuretics can be used for weight reduction. 8. who are not anemic. Despite these additional sources of iron loss. Iron supplementation has not been demonstrated to improve athletic performance in individuals who are nonanemic. WADA (World Anti Doping Agency) prohibited DEXTRAN in sports All plasma expanders such as albumin.9 NS bag. For athletes who are nonanemic. using 0. pseudoanemia can be observed in athletes with adequate haemoglobin due to an increase in blood plasma in athletes that dilutes their haemoglobin concentration.7. however. 10. . Only after the completion of the IV test dose should the remainder of the iron dextran be added to the 500 cc 0. and boxing. should be available during the infusion. male athletes have normally been observed to receive adequate amounts of dietary iron at the same levels recommended for the average male.D. the time required to complete the workout dropped from 91 minutes with 'normal blood' to just 81 minutes after either the dextran. and should generally be judged on an individual basis. Female athletes. Flush medication through tubing. Document on appropriate patient forms. such as weight-lifting. Since actual body temperatures were the same in the three different trials. judo.D. Administration rate should not exceed 500 mg/hr. and hydroxyethyl starch(HES) are prohibited in all types of sport. but this may be caused more from blood loss from menstruation than from athletic activity. Advantages First. its effects remain unclear in athletes that are nonanemic. wrestling. this meant that the blood-volume augmentation allowed the athletes to work harder without overheating.or training-induced blood upswing. but not necessarily at bedside. Bodybuilders use plasma expanders to lose body water and thereby put their muscles into better relief (cosmetic effect) besides increase the number of red blood cells in order increase the production of oxygen. Sweat rates were also up by 10 per cent after either the dextran or training manipulations. When an athlete should be recommended to take iron supplements is debated. Also. dextran. Additionally. 9. Administer full dose of Fe dextran via IMED pump over 2-6 hours as ordered by M. making it appear as if they are anemic when they actually have an adequate amount of total haemoglobin. NOTE: M. and whether athletes with low iron.

iron supplementation should be directed by a medical professional based off a clinical assessment of the athlete’s iron Dextran parameters and not undertaken as self-medication. decreased factor VIII. Dextran may function to stave off iron-deficient anemia.3% at three concentration levels between 53 and 1186 microg/mL. In 96% of the investigated doping control samples. The dextran polymer was enzymatically hydrolysed by alpha-1. drug interactions. saccharose and isomaltose. The method was used to determine the basal concentration of isomaltose resulting from the enzymatic hydrolysis of polymeric 1. 3. 2.however. allowing the chromatographic separation of different disaccharides. Precipitation of acute renal failure: A possible mechanism for this is the accumulation of the dextran molecules in the renal tubules causing tubular plugging. Due to risks associated with differing individual tolerances. Even the highest concentrations were approximately 100-300-fold lower than concentrations found in urine samples of patients after intravenous application of dextran. and overdosing. The assay limit of detection was 3. Recovery ranged from 97 to 112% (mean 106. Detection of Dextran in athelete’s body 1. Renal failure following dextran use is more often reported when renal perfusion is reduced or when preexisting renal damage is present. Disadvantages 1. Dextrans also increase erythrocyte sedimentation rate.9%).5 microg/mL. increased fibrinolysis and coating of endothelium is decreased.9 to 7. enabling the identification and quantification of the plasma volume expander dextran in human urine.5 microg/mL. 4.6-linked glucose in 238 routine doping control samples.and intra-assay coefficients of variation for dextran ranged from 4. . Anaphylactic reactions: Dextrans cause more severe anaphylactic reactions than the gelatins or the starches.8 microg/mL and the lower limit of quantification was 12. such as lactose. A reliable method based on liquid chromatography-tandem mass spectrometry (LC-MS/MS) was developed for doping control purposes. The reactions are due to dextran reactive antibodies which trigger the release of vasoactive mediators. In addition the concentration of dextran measured as isomaltose was estimated in seven urine specimens obtained from patients treated with dextran. The inter. Larger doses of dextran have been associated with significant bleeding complications. The presented results demonstrate the capability and reliability of the developed LC-MS/MS method for the identification and quantification of dextran in human urine and can be regarded as a method revealing the misuse of dextran in sports. Interference with cross-match: Dextrans coat the surface of red blood cells and can interfere with the ability to cross-match blood.6-glucosidase (dextranase) followed by acetylation of the generated isomaltose subunits. Coagulation abnormalities: Dextrans lead to decreased platelet adhesiveness. Incidence of reactions can be reduced by pre-treatment with a hapten (Dextran 1). the concentrations of isomaltose were below the LLOQ of 12. as well as prevent excess absorption of toxic metal ions of lead and cadmium. Calibration curves for dextran were linear and reproducible. as well as the identification and quantification of the analyte in human urine. Identification and quantification of the plasma volume expander dextran in human urine by liquid chromatography-tandem mass spectrometry of enzymatically derived isomaltose Plasma volume expanders are used in sports in order to control haematological parameters and/or to mask erythropoietin (EPO) misuse.

In conclusion. in order to winning a game a player should not put himself under the risks of Dextran and harm his life.Examples of sports that needed the use of Dextran Cycling Skiing Basketball Football Swimming Rugby Volleyball CONCLUSION Dextran may cause many serious side effects to the users. Besides that being disqualified due to the presence of this plasma expanders in the body of athletes is even shameful than losing after the competition. .Doping Agency) and as well as by the IOC( International Olympic Committee). athletes should go for other supplements which are recognized by the WADA( World Anti. Healthy lifestyle should be maintained and gained in order to win any competition.

org/ .0000 http://www. 5.REFERENCES: BOOKS: 1. 3.nlm.nih. 2. 4. http://www.drugs.html http://www.int/medicinedocs/documents/h5774e/h5774e.gov/pmc/articles/PMC2962812/#!po=55. 6.nih.gov/pmc/articles/PMC2439527/ http://apps.com/drug-class/plasma-expanders.ncbi.pdf http://www.pdf http://www.de/pdf/DI/103/49/a3340e.aerzteblatt.who.nlm. WHO DRUG INFORMATION. INTERNET: 1. 2.ncbi. 3rd edition. Iron and health.wada-ama. TSO information and publishing solutions.1989. Vol 1. Norwich.